Airway obstruction – ALS

ALS - Tracheostomy obstruction.
Advanced Life Support airway obstruction.

You are called urgently by the nurses from the respiratory ward.  A patient with a previous stroke who has a tracheostomy has suddenly desaturated.  As you attend, you notice the tracheostomy appears to be several centimetres out from where it should sit.  The nurses are administering oxygen both via the face and via the tracheostomy.  You try to pass a suction catheter but does not progress.  The patient is continuing to desaturate, so you remove the tracheostomy.  The patient is not breathing.  You call the cardiac arrest team and meanwhile, which is the most appropriate step?:
a) Ventilate via an LMA applied to the tracheostomy stoma.
b) Reinsert the tracheostomy tube an ventilate through it.
c) Pass an introducer (bougie) through the tracheostomy stoma and insert a 6.0 cuffed endotracheal tube over the bougie.
d) Sedate and proceed with standard endotracheal intubation.

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